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Pilot
Pilot is a 1st season and the series premiere episode of House, which first aired on November 16, 2004. A young kindergarten teacher is brought to the hospital and diagnosed with inoperable brain cancer by Wilson. When she doesn't improve with treatment, Wilson seeks out House for another opinion. When House fumbles the initial diagnosis, the patient tires of being a guinea pig just as House feels he has found the right answer. Meanwhile, new hire Eric Foreman tries to get used to working with the world's most difficult diagnostician. Cuddy, frustrated with House's lack of a work ethic, decides to go to extreme measures to get House back into the habit of working in the clinic. Although the style of this episode sets it apart (which is understandable for a pilot episode), what strikes many fans of the show is how little changed between the pilot and the rest of Season One. In many cases, shows are entirely reworked and recast after they are picked up by a network, but the plot devices, characterizations and casting of each character are entirely consistent not only with Season One, but the rest of the series as well. Although many thought the character of Gregory House was unbelievable for his bad behavior, his behavior not only doesn't improve through most of the series, it often gets worse. As for the others, Cuddy remains the stressed-out manager, Wilson the easygoing best friend, Foreman the ambitious achiever, Cameron the innocent ingenue and Chase the talented slacker. In March 2012, Robert Sean Leonard who played James Wilson said in an interview that this was still his favorite episode of House. He praised the simplicity of its story and its lack of sensationalist plot elements. He also noted that for most of the episode, House himself seldom appeared, preferring to stay in the background as a shadowy character who was merely talked about by the rest of the cast, who carried the story themselves. Recap Rebecca Adler, A kindergarten teacher, suddenly begins speaking gibberish and becomes confused in front of her class. Her panic mounts, and she hastily scribbles the words "Call The Nurse" on the whiteboard before collapsing in a Grand Mal seizure. A month later, Dr. James Wilson introduces the teacher's case to his close friend Dr. Gregory House, a diagnostician. House is worried people will think he's a patient because of his limp. When Wilson suggests he wear a lab coat, House tells him he's afraid people will think he is a doctor. House thinks that the patient has a brain tumor, but Wilson asks him to take the case because she's his cousin. Wilson doesn't think it's cancer because she isn't improving with radiation therapy. Wilson reminds House that he has three overqualified doctors working for him that would love to work on the case. House meets with his diagnostic team and reminds them that "everybody lies". New hire Eric Foreman wonders why House isn't with the patient, but Allison Cameron tells him that House doesn't like meeting patients. At this point, House has stopped thinking it's a tumor. Robert Chase thinks it is an aneurysm or stroke. Cameron thinks it might be mad cow disease. Foreman thinks it might be Wernicke's encephalopathy, despite a negative blood test. House tells them all to proceed with the appropriate tests. Lisa Cuddy, the Dean of Medicine, comes looking for House to berate him for not working hard enough, including being six years behind in clinic duty. He says he's going home—he can't be fired because he has tenure and is always at the hospital during his assigned work hours. Cuddy agrees that he still has a good reputation, but it will go to hell if he doesn't do his job. Cameron and Foreman begin a test, but it's cancelled on Cuddy's orders—she's taken away all of House's hospital privileges, the only thing she has the power to do to House without board approval. An enraged House confronts her, but she's unconcerned with his threats. She tells him to go and do his job. He tells the team to do the MRI, then goes to do clinic duty. The team starts the MRI, but the patient feels ill and then starts to have trouble breathing. They get her out of the MRI, but she isn't breathing because of pulmonary edema. Chase performs a tracheotomy and intubates her. He then compliments Cameron on realizing the patient was in distress so that they could get her out of the machine in time. They manage to stabilize the patient and get her conscious. She had an allergic reaction to the dye used in the contrast study. House tells the team to give the patient high doses of prednisone. He thinks she might have vasculitis, despite its unlikeliness. They can't do a biopsy to confirm, and the only way to test her is to give her the drugs and see if she responds. However, the patient realizes they aren't treating her for cancer, and is relieved she might not have a tumor. Chase is upset that they might be misleading the patient into thinking she doesn't have cancer. Foreman goes to the classroom to do an environmental scan. He finds a parrot and thinks it might be psittacosis. House dismisses this because none of the kids are sick and it is unlikely five-year-olds would take more hygiene precautions than their teacher. House tells him to break into the patient's apartment to do another environmental scan. Foreman is resistant, but House knows that Foreman broke into someone's house and was arrested when he was sixteen. House found out from one of his teachers; he says that's why he hired Foreman. Foreman reminds House he can't be fired for refusing to break into someone's home. Cuddy asks House why he is giving the patient steroids. She comes to the conclusion that House is guessing and she wants to stop the treatment. They argue about who is in charge. She reminds House he has no evidence that the patient has vasculitis. He asks her why she's so afraid of making mistakes. Cuddy goes to see the patient and stop the steroids, but when she arrives she finds that the patient has improved greatly and has an appetite. Cuddy realizes she may have been wrong. Wilson examines the patient, who really wants to meet House. She asks if he's a good man. Wilson says House is a good doctor. He does admit that House is his friend, and that House may even care about him. Suddenly, the patient complains that she can't see, then has a seizure. Her heart rate skyrockets and she goes into cardiac arrest. They defibrillate the patient and test her for brain damage by having her arrange pictures to form the elements of a story, but she can't manage it. However, she passes the test five minutes later. They realize that although her sight has returned, her brain is dying. House tells them to stop all treatment because each of the possible diagnoses has a different time line. It isn't a tumor and the steroids helped, but they don't know why. House admits he is stumped. Foreman decides to follow House's orders to break into the patient's house and asks Cameron to come along because the police are usually easier to deal with when a pretty white girl is around. Foreman and Cameron search the patient's home. Foreman discusses his former criminal record. Cameron says she was 17 before she had a criminal record. Foreman fixes himself a sandwich and says he's a bit upset he got the job because of his criminal record and not his perfect academic record at both Columbia University and Johns Hopkins Medical School. Cameron says she didn't do nearly as well as Foreman in school and starts wondering how she got the job. They report to House that they couldn't find anything to explain her symptoms, but Foreman reports that she isn't Wilson's cousin—she had ham and Wilson is Jewish. Wilson bluffs, but then gets the patient's name wrong. House calls Foreman an idiot—House has realized that Rebecca may have neurocysticercosis (a tapeworm) from eating pork, something that would never have occurred to him if he still believed the patient was Jewish. That would explain why she reacted well to the steroids initially, but then got worse: tapeworms usually stay in the digestive system, but the eggs can pass into the bloodstream and then flourish anywhere, including in the brain. If the tapeworm is healthy, the immune system (and patient) never even detect it. However, when the tapeworm dies, it stirs up the immune system and causes swelling in the area, in this case Rebecca's brain. Even though the test for parasites was negative, it is a false negative in about 30% of cases where the parasite is present. There is no other way to test for it except by trying to treat it. However, the patient is tired of being treated and wants to go home and die. House tells the patient she is an idiot for refusing treatment. She reminds him that his previous diagnosis was wrong. She asks why he's crippled and he explains that he had an infarction in his thigh and they didn't figure out what was wrong until it was too late to treat it. He tells her few people get to experience pain like muscle death and admits to the patient at the time he hoped he would die from the pain. She thinks he avoids patients because he doesn't want people to see him crippled. He tells her there is no way to die with dignity—everyone dies and it's always ugly. You can only live with dignity. The patient still refuses treatment. The team wants House to claim she's mentally incompetent, but he won't do it. He's solved the case and he feels the work is done. The patient wants proof, but House can't do that. Chase says there might be a way to prove it to her—do an X-ray in her leg where there is likely to be another worm. Although they have the same density as cerebro-spinal fluid, they don't have the same density as muscle. House enthusiastically agrees. They do the X-ray and find a worm larva. She agrees to the drug treatment and is surprised that it only takes two pills a day for a month. There are side effects, but they are manageable. Cameron asks House why he hired her. He says he hired Foreman because of his criminal record, Chase because his dad called, and Cameron because she was extremely pretty. When she is shocked, he says he did it because she worked hard despite the fact she didn't have to. Gorgeous women usually opt for an easy life and they don't go to med school to work really hard unless they are damaged. At that moment, Cameron's pager goes off. They manage to bring the patient's class in to visit her despite the rule about "family only". House asks Wilson why he lied about the patient being his cousin. He says it got House to take the case. They talk about lying while watching a medical drama. Clinic Patients House is finally forced to go to the clinic for the first time in nearly six years. Cuddy gives him an interesting case—a patient with bright orange skin. He tells the patient his wife is having an affair because she hasn't noticed the color change, which was caused by eating too many carrots and taking too much niacin. The patient asks to have House fired for making him think his wife was having an affair, but Cuddy won't do it because he's the best doctor they have. We see that the patient is no longer wearing his wedding ring. The next patient is a 10-year-old boy with asthma. The mother is not giving him his steroids because she's worried about the side effects. House reminds the mother her last doctor weighed no drugs against no oxygen. He suddenly realizes something and goes back to his dying patient, but tells the mother if she doesn't trust steroids, she shouldn't trust doctors. The next patient thinks he has chronic fatigue syndrome or fibromyalgia. House thinks he is just getting older. House buys some mints and puts them in a Vicodin bottle, which he then gives to the patient. House keeps the Vicodin for himself. The patient later comes back for a refill. Zebra Factor 7/10 Neurocysticercosis is the most common parasitic neurological disease in the world. It is very common in the developing world, but is somewhat rarer in New Jersey. In a patient with no history of foreign travel, it is very rare. Major Events * Gregory House, the head of Diagnostic Medicine, his team of Robert Chase, an intensive care specialist, Eric Foreman, a neurologist, and Allison Cameron, an immunologist, House's best friend James Wilson who is also the Head of Oncology and Lisa Cuddy, Dean of Medicine are all introduced for the first time. * House reveals that Foreman was a car-thief during his teenage years. * Cameron admits she was arrested at the age of 17. * After having his authority pulled by Cuddy, House grudgingly starts working at the clinic after a six-year absence. He will make up his time by 2054. * House is revealed to have developed an addiction to the pain medication, Vicodin, and reveals that his limp was the result of an infarction. * Cameron learns that House hired her because she's extremely pretty. He explains that she could have just been given anything in life, married rich as an example, yet she chose to work hard for her lot in life. Therein lied her advantage over other more qualified applicants. She also discovers that he hired Foreman due to his juvenile record and Chase because his father made a phone call. Title The title of the episode comes from the fact that this is the pilot episode of the show, shot in order to attempt to sell the series to a network. It also goes by the unofficial title "Everybody Lies". In foreign markets, the title of this episode often refers to this unofficial title. Trivia and Cultural References * The Wikipedia article on this episode was the featured article for November 24, 2010. * The pilot was filmed with an orange hue lens. * Unlike the rest of the series, this episode was filmed in Vancouver, British Columbia. The rest of the series was shot in Los Angeles. * The patient's name, Rebecca Adler, is a reference to Irene Adler, the female foil of Sherlock Holmes. * Rebecca's unseen boyfriend was named Brad. * House has harsh words for the quality of HMO's or Health Maintenance Organizations, which manage health care for insurance companies. * Trenton is the capital city of New Jersey. It is very near Princeton, just across the Pennsylvania border on the Delaware River. However, Trenton County Hospital is fictitious. * The New England Journal of Medicine is the oldest and most prestigious peer reviewed medical periodical in the United States. * The name of the family whose house Foreman broke into as a teenager was "Felker". *Tuskegee is a reference to a clinical study starting in the 1930s where African-American men with syphilis were deliberately not treated for the disease in order to study the disease's progression to see if it differed from the progression of the disease in Europeans. The study continued well after the discovery in 1947 that penicillin was effective against the disease at any stage. Doctors deliberately kept their patients in the dark about the fact they had syphilis and even went so far as to ensure they were denied entry into the Army during World War II, where they would have been treated. The study was only discontinued in 1972 when it became public in the press. The study only showed that syphilis affected African-Americans the same way it affected Europeans. See also the episode Informed Consent where the same issue is raised. *Mengele is a reference to Josef Mengele, a Nazi physician at the infamous Auschwitz death camp. Not only did Mengele make daily decisions about who was fit enough to work at the camp and who would be immediately gassed, he performed pointless experiments, often on sets of identical twins. Mengele survived the war and escaped to Argentina, where he died in 1979 never having faced justice. *Jewish dietary laws prohibit the consumption of any animal with cloven hooves if it does not chew its cud. As such, all products derived from the pig are non-Kosher and may not be consumed by observant Jews. Later in the series, we learn that Wilson isn't particularly observant and keeps bacon in his refrigerator. *House says, "As the philosopher Jagger once said, 'You can't always get what you want.'" Jagger refers to Rolling Stones lead singer Mick Jagger. "You Can't Always Get What You Want " is a song by Rolling Stones. The beginning of the song is heard at the end of the episode. *General Hospital is a soap opera on ABC. It is the longest running soap opera still in production (as of 2020) and the third longest running dramatic series of all time. It has won 13 Daytime Emmys for Most Outstanding Drama Series, a record. House is watching it in two scenes. *The 2007 Scrubs ''episode "My House" is an homage to the series in general and this episode in particular, with a reference to the Orange Man and a character appearing with a cane. *This episode gave David Shore his first nomination for a Humanitas Prize, which instead was awarded to the writer of an episode of ''The West Wing. ''However, Shore won the Humanitas the following year for another first season episode, Three Stories. *A version of the episode exists with a couple of extra minutes of footage. It was distributed only on DVDs sent to certain subscribers to ''Entertainment Weekly. *Christopher Hoag scored the episode and was nominated for an Emmy for "Outstanding Music Composition for a Series (Dramatic Underscore)" for this work. This was Hoag's only work on the series, with the remaining episodes all being scored by Jon Ehrlich and Jason Derlatka. Reviews The show did not get off to a strong start. It finished 62nd in the ratings the week it premiered with about 7 million viewers. Although many of the reviewers thought Gregory House was a unique and fresh character, they challenged the plausibility of the main premise of the show—that a doctor who behaved with such cruelty would be tolerated because of his talent. Reviewers also thought the rest of the characters were largely stereotypes and that the premise of a doctor who consistently finds a string of rare diseases to diagnose was implausible. However, the show was reviewed better than a similar show, Medical Investigation. ''Critics thought MI was too plot driven and liked how ''House, M.D. was more character driven. Reviewers also preferred House's character to the characters on the competing show. Re-reviewing the Pilot later in the series, Blogcritic noted that House's characterization has barely changed from his appearance in this episode. It also notes something important—House has trouble opening up to friends and colleagues, often using humor and sarcasm to deflect. However, he has no problem opening up to Rebecca and sharing his near-death experience with her. This is a consistent pattern through the series and points out that perhaps the reason House hates meeting patients is not for the reasons he states (they lie and they're boring), but because he has problem keeping his composure around them. This does back up one of House's other reasons for not meeting patients—he doesn't want to get emotionally invested in the case because he knows his objectivity will suffer. The critic also noted how well crafted the show was from the very beginning—very little that appeared in the Pilot had to be changed once the series started. *TV.com users rated the episode 8.9. They picked Gregory House as the most valuable character. *IMDB users rated the episode 8.7 with 39.7% rating it 10 Medical Ethics *Cuddy has a point about House treating the patient based on a guess. In the past, patients were often treated as involuntary guinea pigs to test out a doctor's theories and were rarely told about the risks of the procedure involved. In this case, it's obvious that the team didn't explain the risks of steroids to Rebecca before she was given them. Luckily, in a real case of neurocysticercosis, steroids probably would not have had an adverse impact because the tapeworm already has the ability to suppress the immune response. However, if Rebecca had suffered from an infection, steroids would have made it worse. *One of the most controversial issues in American medicine is the right to end medical treatment, including diagnostic procedures. Although the supposed "death panels" in the Affordable Care Act have been greatly derised, many patients who come to emergency rooms are at the end of life, generally due to advanced old age. However, in this case, if Rebecca's disease can be diagnosed and treated, it is likely she would live a normal lifespan. One of the most controversial points made against end-of-life advocate Dr. Jack Kevorkian was that many of the patients he helped commit suicide were nowhere near death and in some cases, were not even suffering the early manageable symptoms of their conditions. Rebecca's mental state should certainly be reviewed when she refuses treatment, and this point was also made more forcefully in other episodes such as DNR, Informed Consent and Painless. In Resignation, the patient actually was suicidal. In Three Stories, we also found out that many people fear things other than death and that these feelings are often not entirely rational in the circumstances. Goofs *While on the bus and while running to work, Rebecca's sweater is blue. However, when she talks to Melanie and goes to class, the sweater is green. *When Rebecca arives in class, a young girl with long hair in the front row is seated. However, when the camera angle changes, the same girl is seen approaching her seat. *Brain tumors are diagnosed with imaging (even small ones will show up)—then, if necessary, a biopsy. Relying on lab tests (particularly negative lab tests) is just bad medicine. Also, given the side effects of radiation, treating her without confirmation would be a particularly bad idea. *Chase's incision for the tracheotomy is too large. It has to be just large enough to insert the tube. *If a patient suffers an anaphylaxis attack that results in respiratory arrest, the doctors should call a Code Blue before they start trying to correct the situation themselves. In most cases, the patient will require a lot more support than even three doctors can provide, such as setting up an intravenous line. *Although it's likely that the anaphylaxis was the result of the contrast, you can't just assume it wasn't something else in the environment. *Pharmacists don't just hand out Vicodin (or other narcotics) to doctors. They would only provide the medication directly to the patient. *Steroids don't make neurocysticercosis better, then worse. When a patient is properly treated with albendazole, the death of the worms often causes a severe immune reaction which in and of itself can be life-threatening. As such albendazole is usually given together with steroids to lessen the chance of an immune reaction. However, if the steroids are discontinued too early, the patient can develop the immune reaction as well. *Yes, House is using the cane in the wrong hand. However, it is revealed later in the series that he does this deliberately. *Noting that it is 12:52 p.m., House announces that General Hospital will be on in eight minutes. However, in the Eastern Time Zone, it airs at 3:00 p.m. *It is strange that there is a tracheotomy kit in the MRI room as most cutting implements are made out of steel. The kit would have to be made out of non-ferrous metal if it were in the MRI room. *After the tracheotomy tube is removed, the bandages used to cover the wound are too high. A tracheotomy is performed where the neck meets the chest so wrapping a bandage around the neck would not be sufficient. *Actress Rekha Sharma is identified as Reika Sharma in the credits. Gallery The gallery for Pilot can be found here. Quotes :'Rebecca Adler:' "''Am I ever going to meet Dr. House?" :Wilson: "Well, you might run into him at the movies, or on the bus." :Rebecca: "Is he a good man?" :Wilson: "He's a good... doctor." :Rebecca: "Can you be one without the other? Don't you have to care about people?" :Wilson: "Caring is a good motivator. He's found something else." :—Pilot :House: "Gorgeous women do not go to medical school... unless they're as damaged as they are beautiful. Were you abused by a family member?" :Cameron: "No." :House: "Sexually assaulted?" :Cameron: "No." :House: "But you are damaged, aren't you?" :—Pilot :Cameron: "Can't diagnose that without a biopsy." :House: "Yes, we can. We treat it. If she gets better, we know we're right." :Cameron: "And if we're wrong?" :House: "We'll learn something else." :—Pilot :House: "See that? They all assume that I'm a patient because of this cane." :Wilson: "So put on a white coat like the rest of us." :House: "I don't want them to think I'm a doctor." :Wilson: "You see where the administration might have a problem with that attitude?" :House: "Ehh, people don't want a sick doctor." :Wilson: "That's fair enough. I don't like healthy patients." :—Pilot :Rebecca: (about House) "He's your friend, huh?" :Wilson: "Yeah." :Rebecca: "Does he care about you?" :Wilson: "I think so." :Rebecca: "You don't know?" :Wilson: "As Dr. House likes to say, 'Everybody lies.' ''" :'Rebecca:' "''It's not what people say. It's what they do." :Wilson: (pause) "Yeah. He cares about me." :—Pilot :Cuddy: "Patient is orange." :House: "The color?" :Cuddy: "No, the fruit." :House: "You mean yellow; it's jaundice." :Cuddy: "I mean orange." :House: "Well, how orange?" :—Pilot :Child: "Why are you smelling Vinny's pants?" :Foreman: "I'm not." :Child: "Looked like you were." :Foreman: "I was smelling the floor." :Child: "Oh." :—Pilot :Cameron: "Kind of hard to work for a guy who doesn't respect you." :House: "Why?" :Cameron: "Is that rhetorical?" :House: "No. Just seems that way cause you can't think of an answer." :—Pilot The Audition Scene This is the scene that the actors trying out for the House character had to play out, including Hugh Laurie. It's repeated in this episode. Cuddy: I was expecting you in my office 20 minutes ago. House: Really? Well, that’s odd, because I had no intention of being in your office 20 minutes ago. Cuddy: You think we have nothing to talk about? House: No, just can’t think of anything that I’d be interested in. Cuddy: I sign your paychecks. House: I have tenure. Are you going to grab my cane now, stop me from leaving? Cuddy: That would be juvenile. I can still fire you if you’re not doing your job. House: I’m here from 9 to 5. Cuddy: Your billings are practically nonexistent. House: Rough year. Cuddy: You ignore requests for consults. House: I call back. Sometimes I misdial. Cuddy: '''You’re 6 years behind on your obligation to this clinic. '''House: See, I was right, this doesn’t interest me. Cuddy: '''6 years, times 3 weeks; you owe me better than 4 months. '''House: It’s 5:00. I’m going home. Cuddy: '''To what? '''House: Nice. Cuddy: Look. Dr. House, the only reason that I don’t fire you is because your reputation is still worth something to this hospital. House: Excellent, we have a point of agreement. You're not going to fire me. Cuddy: Your reputation won’t last if you don’t do your job. The clinic is part of your job. I want you to do your job. House: '''Well, as the philosopher Jagger once said, "You can’t always get what you want." Cast * Hugh Laurie as Dr. Gregory House * Lisa Edelstein as Dr. Lisa Cuddy * Omar Epps as Dr. Eric Foreman * Robert Sean Leonard as Dr. James Wilson * Jennifer Morrison as Dr. Allison Cameron * Jesse Spencer as Dr. Robert Chase * Robin Tunney as Rebecca Adler * Andrew Airlie as Orange Guy * Rekha Sharma as Melanie Landon * Maya Massar as Asthma Mom * Dylan Basu as Asthma Boy * Ava Hughes as Sydney * Kyarra Willis as Kid Two * Ethan Kyle Gross as Molnar * Candus Churchill as Substitute Teacher * Michale Ascher as Egg Salad Lady * Alana Husband as Tech * Janet Glassford as Reception Nurse * Mycole Metcalf as Doctor * Rachel Lana Li as Child in classroom * Maria Nicotero in various roles * Ian Thompson as Bus Driver Release Dates *United States - November 16, 2004 *United Kingdom - June 9, 2005 *Israel - June 11, 2005 *Australia - June 26, 2005 *Italy - July 1, 2005 *Iceland - September 1, 2005 *Spain - September 27, 2005 *Estonia - December 16, 2005 *France - March 1, 2006 *Hungary - March 22, 2006 *Germany - May 9, 2006 *Netherlands - August 2006 *Sweden - September 19, 2006 *Finland - September 21, 2006 *Mexico - January 10, 2007 In other languages Links *House MD Medical Case Analysis *Episode page at IMDB *Episode article at Wikipedia (Featured article) *Episode page at House MD Guide *A study guide for English as a Second Language students *Episode summary at Scepticemia *Episode review at Blogcritics *A Yahoo! question regarding why the style of this episode is so different *Quotes at House MD Quotes *Episode article at TVIV *Episode guide at Ace Showbiz *A wisenheimer reviews the Pilot episode in light of later events in the series *A review at Television Without Pity *A guide to the diagnosis at House MD Guide *Episode page at TV.com Video ''This article was the featured article for July, 2014''''' http://es.dr-house.wikia.com/wiki/Todo_el_mundo_miente de:Schmerzensgrenzen es:Piloto Category:Episodes Category:Season 1 Category:Spanish Category:Zebra Factor 7 Category:Featured articles Category:Season 6